Goenjian, A. K., Karayan, I., Pynoos, R. S., Minassian, D., Najarian, L. M., Steinberg, A. M., & Fairbanks, L. A. (1997). Outcome of psychotherapy among early adolescents after trauma. American Journal of Psychiatry, 154(4), 536–542. https://doi.org/10.1176/ajp.154.4.536

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 64

Population:

• Age — Mean=13.2 years
• Race/Ethnicity — Not specified
• Gender — 42 Female and 22 Male
• Status — Participants were adolescents exposed to the 1988 earthquake in Armenia.

Location/Institution: Gumri, Armenia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of the Trauma/Grief-Focused Group Treatment program [now called Trauma-Grief Component Therapy for Adolescents (TGCT-A)] on adolescents exposed to the 1988 earthquake in Armenia. Participants were students in two schools receiving trauma/grief-focused brief psychotherapy and students at two schools who were not treated with psychotherapy. Measures utilized include the Child Posttraumatic Stress Disorder (PTSD) Reaction Index and the Depression Self-Rating Scale (DSRS). Results indicate that the severity of posttraumatic stress symptoms significantly decreased among participants receiving TGCT-A, while severity of these symptoms increased significantly among the subjects not treated with psychotherapy. There was no change in severity of depressive symptoms in the TGCT-A group, while depressive symptoms among subjects not treated with psychotherapy significantly worsened over time. Limitations include the lack of randomization, small sample size, and reliance on self-reported measures.

Length of controlled postintervention follow-up: 18 months.

Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pašalić, A., Duraković, E., Mušić, M., Ćampara, N., Ðapo, N., Arslanagić, B., Steinberg, A. M., & Pynoos, R. S. (2008). Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 47(9), 1048–1062. https://doi.org/10.1097/CHI.0b013e31817eecae

Type of Study: Randomized controlled trial
Number of Participants: 127

Population:

• Age — 13–19 years
• Race/Ethnicity — Predominantly ethnic Muslim
• Gender — 65% Female and 35% Male
• Status — Participants were adolescents exposed to trauma.

Location/Institution: 10 secondary schools - Central Bosnia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the comparative effectiveness of 1) a classroom-based psychoeducation and skills intervention and 2) the classroom-based psychoeducation and skills intervention combined with a school-based Trauma- and Grief-Focused Group Treatment [now called Trauma-Grief Component Therapy for Adolescents (TGCT-A)] for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity. Participants were randomized to receive the classroom-based psychoeducation and skills intervention alone, or the classroom-based psychoeducation and skills intervention combined with TGCT-A. Measures utilized include the Posttraumatic Stress Disorder Reaction Index (RI), Depression Self-Rating Scale (DSRS), and UCLA Grief Inventory. Results indicate there were significant pretreatment to posttreatment reductions in PTSD and depression symptoms in both the TGCT-A and comparison conditions, but significant reductions in maladaptive grief reactions only in the TGCT-A group. Moreover, significant symptom improvement between posttreatment and 4-month follow-up was observed in both the TGCT-A and comparison conditions on measures of PTSD and depression symptoms. Limitations included that both the TGCT-A group and the comparison group received the classroom-based arm of the intervention, making it difficult to attribute effects, small sample size for some analyses, and the short length of follow-up.

Length of controlled postintervention follow-up: 4 months.

CATS Consortium. (2010). Implementation of CBT for youth affected by the World Trade Center disaster: Matching need to treatment intensity and reducing trauma symptoms. Journal of Traumatic Stress, 23(6), 699–707. https://doi.org/10.1002/jts.20594

Type of Study: Other quasi-experimental
Number of Participants: 306

Population:

• Age — 5–21 years (Mean=11.6 years)
• Race/Ethnicity — 63% Latino, 13% African American, 11% White, and 7% Other
• Gender — Not specified
• Status — Participants were children and youth affected by the September 11th disaster and other traumatic events.

Location/Institution: New York State Office of Mental Health

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare and assess the effectiveness of trauma-specific CBT versus a brief CBT skills intervention with traumatized youth in a post-disaster context. Participants were need-based assigned on the basis of trauma symptom severity to either trauma-specific CBT (moderate to severe trauma symptoms) or brief CBT skills (mild trauma symptoms). Participants aged 5–12 with moderate to severe trauma symptoms were assigned to Trauma-Focused Cognitive Behavioral Therapy Treatment (TF-CBT), while adolescents (ages 13–21) with moderate to severe trauma symptoms were assigned to trauma-specific CBT [now called Trauma-Grief Component Therapy for Adolescents (TGCT-A)]. Measures utilized include the UCLA Posttraumatic Stress Disorder Reaction Index, the Strengths and Difficulties Questionnaire, and the Behavioral and Emotional Rating Scale. Results indicate that at 6-months postbaseline, both groups had improved. The rate of change over time was not significantly different for the trauma-specific CBT group versus the brief CBT skills comparison group. Both groups improved over time and their trauma symptoms decreased. Limitations include lack of randomization and inability to assess treatment fidelity to either of the treatment models.

Length of controlled postintervention follow-up: 6 months.

Clow, S., Olafson, E., Ford, J., Moser, M., Slivinsky, M., & Kaplow, J. (2023). Addressing grief reactions among incarcerated adolescents and young adults using trauma and grief component therapy. Psychological Trauma: Theory, Research, Practice, and Policy, 15(S1), S192–S200. https://doi.org/10.1037/tra0001364

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 63

Population:

• Age — 10–21 years (Mean=17.6 years)
• Race/Ethnicity — 62% African American/Black, 13% Missing, 10% American Indian/Alaskan Native, 5% Hispanic, 5% Unknown/Other, and 5% White
• Gender — 100% Male
• Status — Participants were adolescents incarcerated at a juvenile residential facility.

Location/Institution: A secure correctional facility in the Midwestern United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether male adolescents incarcerated in a juvenile justice facility would participate in and benefit from a grief-focused, evidence-based group treatment program. Participants were juveniles participating in the Trauma and Grief Component Therapy for Adolescents (TGCTA) [now called Trauma-Grief Component Therapy for Adolescents (TGCT-A)] treatment program and a control group of juveniles who were not participating in the TGCTA treatment program. Measures utilized include the Persistent Complex Bereavement Disorder (PCBD) Checklist and administrative data from the Department of Corrections. Results indicate that mean PCBD grief domain scores decreased significantly for separation distress and circumstance-related distress from baseline to after TGCTA group participation. After group completion, the association between PCBD grief symptoms and functional impairment was unchanged in the family domain, decreased in the school domain, and increased in the peers/friends domain. In the 5- to 15-week period after the group versus the 5- to 15-week period before the group, there was a 50% reduction in the number of behavioral incident reports involving TGCTA group participants, while 63 matched control participants had no change in behavioral incident reports. Limitations include the quasi-experimental design with a matched control sample for whom PBCD was not assessed, the small sample size, and the follow-up period was limited to 15 weeks.

Length of controlled postintervention follow-up: 15 weeks.

The following studies were not included in rating TGCT-A on the Scientific Rating Scale...

Layne, C. M., Pynoos, R. S., Saltzman, W. R., Arslanagic, B., Black, M., Savjak, N., Houston, R. (2001). Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice, 5(4), 277–290. https://doi.org/10.1037/1089-2699.5.4.277

The purpose of the study was to evaluate the effectiveness of the Trauma/Grief-Focused Group Treatment program [now called Trauma -Grief Component Therapy for Adolescents (TGCT-A)] on war-traumatized adolescents. Measures utilized include the Reaction Index-Revised (RI-R), Child Self-Rating Scale (CSRS), Self-Satisfaction Scale (SSS), Greif Screening Scale (GSS) and Depression Self-Rating Scale (DSRS). Results indicate participation in the Trauma/Grief-Focused Group Treatment program was associated with significant reduction in posttraumatic stress, depression, and grief symptoms between pretreatment and posttreatment. Limitations include lack of randomization, lack of control group, small sample size, reliance on self-report measures, and lack of follow-up. Note: This article was not used in the rating process due to the lack of a control group.

Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A. M., & Aisenberg, E. (2001). Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5(4), 291–303. https://doi.org/10.1037/1089-2699.5.4.291

The purpose of the study was to assess the prevalence of trauma exposure among middle school students and evaluate the effectiveness of a school-based, trauma- and grief-focused group psychotherapy protocol [now called Trauma-Grief Component Therapy for Adolescents (TGCT-A)] in treating a subset of students with severe exposure, posttraumatic stress disorder (PTSD), and functional impairment. Participants were assigned to Trauma/Grief-Focused Group Treatment. Measures utilized include the Community Violence Exposure Survey (CVES), UCLA PTSD Reaction Index—Adolescent Version (RI-R), Reynolds Adolescent Depression Scale (RADS), Grief Screening Scale (GSS), and The UCLA Trauma-Grief Screening Interview. Results indicate that participation in the Trauma/Grief Focused Group Treatment program was associated with significant improvements in posttraumatic stress symptoms, complicated grief symptoms, and grade point average (GPA). Limitations include lack of randomization, lack of control group, small sample size, and lack of follow-up. Note: This article was not used in the rating process due to the lack of a control group.

Grassetti, S. N., Herres, J., Williamson, A., Yarger, H. A., Layne, C. M., & Kobak, R. (2015). Narrative focus predicts symptom change trajectories in group treatment for traumatized and bereaved adolescents. Journal of Clinical Child and Adolescent Psychology, 44(6), 933–941. https://doi.org/10.1080/15374416.2014.913249

The purpose of the study was to evaluate the effectiveness of Trauma-Grief Component Therapy for Adolescents (TGCT-A) in regards to whether the specific focus of students’ narratives (i.e., focus on trauma vs. focus on loss) as shared by TGCT-A group members would predict initial pretreatment levels, as well as pretreatment to posttreatment change trajectories of reducing posttraumatic stress disorder (PTSD) symptoms and maladaptive grief (MG) reactions. Participants were assigned to Trauma-Grief Component Therapy for Adolescents (TGCT-A). Measures utilized include the UCLA PTSD Reaction Index—Adolescent Version (RI-R), Persistent Complex Bereavement Disorder Checklist, and The Short Mood and Feelings Questionnaire. Results indicate that students who constructed trauma-focused narratives reported higher pretreatment levels of PTSD symptoms, whereas students who constructed loss-focused narratives reported higher pretreatment levels of MG reactions. Further, students’ narrative focus predicted the rate of pretreatment–posttreatment decline in MG reactions but not PTSD symptoms; students who constructed loss-focused narratives reported higher rates of decline in MG reactions. Limitations include lack of randomization, lack of control group and small sample size and lack of controlled follow-up. Note: This article was not used in the rating process due to the lack of a control group.

Herres, J., Williamson, A. A., Kobak, R., Layne, C. M., Kaplow, J. B., Saltzman, W. R., & Pynoos, R. S. (2017). Internalizing and externalizing symptoms moderate treatment response to school-based trauma and grief component therapy for adolescents. School Mental Health: A Multidisciplinary Research and Practice Journal, 9(2), 184–193. https://doi.org/10.1007/s12310-016-9204-1

The purpose of the study was to evaluate whether (a) Trauma and Grief Component Therapy for Adolescents (TGCTA) could be implemented in complex juvenile justice systems, (b) would be associated with a decrease in posttraumatic symptoms and reactions in youth, and (c) might contribute to reducing incident reports in facilities. Participants were assigned to Trauma and Grief Component Therapy for Adolescents (TGCTA). Measures utilized include the Brief Problem Checklist (BPC), the Short Mood and Feelings Questionnaire (SMFQ), the Strengths and Difficulties Questionnaire (SDQ), the UCLA PTSD Reaction Index (UCLA-RI), and maladaptive grief measures. Results indicate that students’ distress ratings of their self-identified Top Problem decreased significantly across all three phases of treatment. Students with higher baseline internalizing symptoms benefitted significantly less from treatment during the first phase (focusing on psychoeducation and skills-building) compared to students with lower internalizing symptoms, and benefitted significantly more during the second phase (focusing on trauma or loss-focused narrative construction). In contrast, youth with more baseline externalizing scores showed a trend towards greater reductions in Top Problem ratings during Piece I—the initial skills-building phase of treatment and showed no significant decline in their Top Problem ratings during the narrative-sharing phase (Piece II). Students with more internalizing symptoms showed the most benefit from treatment components in which they shared their trauma narratives or loss narratives. Limitations include lack of randomization of students, lack of a control group, and lack of controlled follow-up. Note: This article was not used in the rating process due to the lack of a control group.